Probe küretaj olgularında remifentanil ve fentanilin uyanma ve hemodinamik parametreler üzerine etkilerinin karşılaştırılması

Yıl 2024, Cilt: 29 Sayı: 3, 336 - 344, 23.09.2024

Erol Karaaslan

https://doi.org/10.21673/anadoluklin.1491696

Öz

Amaç: Supraglottik hava yolu cihazı ile havayolu güvenliğin sağladığımız çalışmamızda fentanil ve remifentanil gibi iki farklı opiodin probe küretaj ogularında uyanma parametreleri, hemodinamik etkiler, anestezi sonrası bakım ünitesi (PACU)’ da kalış süresi, ağrı ve bulantı kusma üzerine etkilerini incelemeyi amaçladık.

Yöntemler: Probe küretaj cerrahisi planlanan 66 hasta Fentanil (Grup F, n = 33) ve Remifentanil (Grup R, n = 33) guruplarına randomize olarak dağıtıldı. Anestezi indüksiyonunda her iki grupta 2.5 mg/kg propofol i.v, Grup F’ de 2.5 mcg/kg fentanil i.v, Grup R’ de ise 2-4 mcg/kg i.v remifentanil bolus olarak uygulandı ve kas gevşetici bir ajan kullanılmadı. Hastanın vücut ağırlığına göre laringeal maske boyutu seçildi ve kaf basıncı bir manometre kullanılarak 60 cm H2O’ya ayarlandı. Anestezi indüksiyonunda her iki grupta 2.5 mg/kg propofol, Grup F’ de 2.5 mcg/kg fentanil, Grup R’ de ise 2-4 mcg/kg i.v remifentanil bolus olarak uygulandı ve kas gevşetici bir ajan kullanılmadı. Hastanın vücut ağırlığına göre laringeal maske boyutu seçildi ve kaf basıncı bir manometre kullanılarak 60 cm H2 O’ya ayarlandı.

Bulgular: Çalışmamızda her iki grubun demografik verileri benzerdi. Ekstübasyon ve uyanma süresi Grup R’de daha kısaydı. Gruplararası fark anlamlı idi (p<0,001). Hemodinamik verilerden ortalama arter basıncı (MAP) değerleri; T1, T3, T5 zaman aralığında Grup R’ de daha düşüktü. Kalp atış hızı (HR) değerleri Grup R’de anlamlı olarak daha düşüktü. Her iki zaman aralığında gruplar arasında istatiksel olarak anlamlı fark vardı (p: 0,014, p: 0,037)

Sonuçlar: Çalışmamızda edilen probe küretaj olgularında remifentanilin fentanile göre daha iyi bir hemodinamik stabilite sağladığı, ekstübasyon ve uyanma sürelerini daha kısa olduğu, bulantı kusma insidansının daha az olduğu görüldü. Bu nedenle supraglottik hava yolu cihazlarıyla birlikte remifentanil kullanımının anestezi yönetiminde iyi bir alternatif olduğunu düşünmekteyiz.

Anahtar Kelimeler

Anesteziden uyanma, fentanil, günlük cerrahi, küretaj, laringeal maske havayolu, remifentanil

Comparison of the effects of remifentanil and fentanyl on awakening and hemodynamic parameters in probe curettage cases

Öz

Aim: We aimed to investigate the effects of two different opioids, fentanyl, and remifentanil, on waking parameters, hemodynamic effects, duration of stay in the post-anesthesia care unit (PACU), pain and nausea and vomiting in patients undergoing probe curettage surgery.

Methods: Sixty-six patients scheduled for probe curettage surgery were randomly divided into Fentanyl (Group F, n = 33) and Remifentanil (Group R, n = 33) groups. For induction of anesthesia, 2.5 mg/kg propofol was administered as a bolus in both groups, 2.5 mcg/kg fentanyl in Group F and 2-4 mcg/kg i.v. remifentanil in Group R. No muscle relaxant agent was used. The laryngeal mask size was selected according to the patient’s body weight. For induction of anesthesia, 2.5 mg/kg propofol was administered as a bolus in both groups, 2.5 mcg/kg fentanyl in Group F, and 2-4 mcg/kg i.v. remifentanil in Group R. No muscle relaxant was used. The laryngeal mask size was selected according to the patient’s body weight and the cuff pressure was adjusted to 60 cm H2O using a manometer.

Results: The demographic data of both groups were similar in our study. Extubation time was shorter in Group R. The difference between the groups was significant (p<0.001). The awakening time was also significantly shorter in Group R (p<0.001). Among the hemodynamic data, MAP values were lower in Group R at T1, T3, and T5 time intervals. HR values were significantly lower in Group R. There was a statistically significant difference between the groups in both time intervals (p: 0.014, p: 0.037)

Conclusions: In our study, remifentanil provided better hemodynamic stability, shorter extubation and awakening times, and lower incidence of nausea and vomiting than fentanyl in probe curettage cases. Therefore, we suggest that the use of remifentanil with supraglottic airway devices is a good alternative in anesthesia management.

Anahtar Kelimeler

Awakening from anesthesia, curettage, day surgery, fentanyl, laryngeal mask airway, remifentanyl

Etik Beyan

Conflict-of-Interest and Financial Disclosure The authors declare that they have no conflict of interest to disclose. The authors also declare that they did not receive any financial support for the study.

Destekleyen Kurum

No

Kaynakça

• Nilsson U, Jaensson M. Postoperative Recovery After General and Regional Anesthesia in Patients Undergoing Day Surgery: A Mixed Methods Study. J Perianesth Nurs. 2019;34(3):517-28.
• Fosnot CD, Fleisher LA. Providing value in ambulatory anesthesia. Curr Opin Anaesthesiol. 2015;28(6):617-22.
• Hamilton E, Ravikumar R, Bartlett D, et al. Dexamethasone reduces emesis after major gastrointestinal surgery (DREAMS). Trials. 2013;14:249.
• Okocha O, Gerlach RM. Preoperative Evaluation for Ambulatory Anesthesia: What, When, and How?. Anesthesiol Clin. 2019;37(2):195-213.
• Warnakulasuriya SR, Patel RC. Patient-reported outcomes for ambulatory surgery. Curr Opin Anaesthesiol. 2020;33(6):768-73.
• Işık Y, Kurdoğlu Z. Comparison of propofol and ketofol in minor gynecologic interventions. J Clin Exp Invest. 2015;6(3):244-9.
• Timmermann A, Nickel EA. Larynxmasken der zweiten Generation: Erweiterte Indikationen. Anaesthesist. 2015;64(1):7-15.
• Schulz KF, Altman DG. CONSORT 2010 statement: updated guidelines for reporting parallel group randomized trials. Int J Surg. 2011;9:672-77.
• Aldrete JA, Kroulik D. A postanesthetic recovery score. Anesth Analg. 1970;49(6):924-34.
• Xu Y, Wu J, Zhao J, et al. Hemodynamics and anesthetic effect of propofol combined with remifentanil in patients undergoing laparoscopic ovarian cystectomy under laryngeal mask airway anesthesia. Am J Transl Res. 2021;13(5):5404-11.
• Arslan AK, Yasar S. WSSPAS: An Interactive Web Application for Sample Size and Power Analysis with R Using Shiny. Turkiye Klinikleri J Biostat. 2018;10(3):224-46.
• Faria EF, Machado RD, Gualberto RJC, et al. Patient’s safety and satisfaction on same day discharge after robotic and laparoscopic radical prostatectomy versus discharge after 24 or 48 h: a longitudinal randomized prospective study. BMC Urol. 2023;23(1):149.
• Abaza R, Martinez O, Ferroni MC, et al. Same Day Discharge after Robotic Radical Prostatectomy. J Urol. 2019;202(5):959-63.
• Ismail SA, Bisher NA. Intraocular pressure and haemodynamic responses to insertion of the i-gel, laryngeal mask airway or endotracheal tube. Eur J Anaesthesiol. 2011;28(6):443-8.
• Blobner M, Hunter JM. Supraglottic airway, tracheal intubation, and neuromuscular block: will the ménage à trois endure?. Br J Anaesth. 2021;127(2):174-7.
• Mendonça FT, Silva SLD. Effects of lidocaine and esmolol on hemodynamic response to tracheal intubation: a randomized clinical trial. Braz J Anesthesiol. 2022;72(1):95-102.
• Zhang L, Bao Y, Shi D. Comparing the pain of propofol via different combinations of fentanyl, sufentanil or remifentanil in gastrointestinal endoscopy. Acta Cir Bras. 2014;29(10):675-80.
• Yang QY, Xue FS. Comparison of bolus remifentanil versus bolus fentanyl for blunting cardiovascular intubation responses in children: a randomized, double-blind study. Chin Med J (Engl). 2009;122(1):44-50.
• Scott LJ, Perry CM. Remifentanil: a review of its use during the induction and maintenance of general anaesthesia. Drugs. 2005;65(13):1793-823.
• Oğurlu M, Küçük M, Bilgin F, et al. Comparison of bolus remifentanil-propofol versus bolus fentanyl-propofol for dilatation and sharp curettage. Clin Exp Obstet Gynecol. 2010;37(3):209-12.
• Ince IE, Iyilikci L, Yilmaz S, et al. Sedation for short hemato-oncologic invasive procedures in children: comparison of propofol-remifentanil and propofol-fentanyl. J Pediatr Hematol Oncol. 2013;35(2):112-7.
• Egan TD, Lemmens HJ, Fiset P, et al. The pharmacokinetics of the new short-acting opioid remifentanil (GI87084B) in healthy adult male volunteers. Anesthesiology. 1993;79(5):881-92.
• Asakura A, Mihara T, Goto T. Does fentanyl or remifentanil provide better postoperative recovery after laparoscopic surgery? a randomized controlled trial. BMC Anesthesiol. 2018;18(1):81.
• Tan M, Law LS, Gan TJ. Optimizing pain management to facilitate Enhanced Recovery After Surgery pathways. Can J Anaesth. 2015;62(2):203-18.
• Uğur B, Şen S, Oğurlu M, et al. Probe Küretaj Uygulamalarında Remifentanil-Propofol ve Fentanil-Propofol Kombinasyonlarının Karşılaştırılması. J Clin Obstet Gynecol. 2007;17(1):30-6.